Author

Lisa Levoir

Published

November 8, 2023

1 Data import and cleaning

In this section I import the data and prepare it for analysis.

Code
```{r setup}
#| warning: false
#| message: false

library(tidyverse)
library(plotly)
library(dplyr)
library(tidyr)
library(knitr)
library(table1) #Create HTML Tables of Descriptive Statistics https://cran.r-project.org/web/packages/table1/vignettes/table1-examples.html
#library(OMTM1) #https://github.com/schildjs/OMTM1/
library(Hmisc)
library(rms) # Regression Modeling Strategies by Frank https://cran.r-project.org/web/packages/rms/index.html
library(modelsummary) #Summary Tables and Plots for Statistical Models and Data: Beautiful, Customizable, and Publication-Ready https://cran.r-project.org/web/packages/modelsummary/index.html
library(scales) # The scales packages provides the internal scaling infrastructure used by ggplot2, and gives you tools to override the default breaks, labels, transformations and palettes. https://scales.r-lib.org
library(viridis) #colors
library(cowplot) #allows me to use plotgrid
library(gridExtra) #adding tables to plots
library(visdat) #shows missing data
library(GGally) #makes pairs plots
library(sandwich) #for robust standard errors
library(gtsummary) #makes the tables look nicer

setwd("/Users/lisalevoir/BIOS7351_Collab/data_project2") #this line I would need to run in the console
knitr::opts_knit$set(root.dir = "/Users/lisalevoir/BIOS7351_Collab/github/BIOS_Collaboration/project_2_analysis") #now I set global options for knitting, I also had to toggle global options > R Markdown > evaluate chunks in current directory


#import the data
dat <- read.csv("/Users/lisalevoir/BIOS7351_Collab/data_project2/combined_data_203.csv")

#to compare that the merging went as expected
VUMSdat <- read.csv("/Users/lisalevoir/BIOS7351_Collab/data_project2/DATA_VUMS.csv")
HMSdat <- read.csv("/Users/lisalevoir/BIOS7351_Collab/data_project2/DATA_HMS.csv")
UVAdat <- read.csv("/Users/lisalevoir/BIOS7351_Collab/data_project2/DATA_UVA.csv")
```

1.0.1 Inclusion/Exclusion

Criteria to exclude students who most likely took a scored exam:

  • Any PhD students (n = 2)

  • Any 5th year program students (n = 19)

  • M4 students at Vanderbilt (n = 5)

  • Students who did not complete either Step survey (n = 2)

  • Students who specifically stated they took a scored Step 1 (n=1)

Based on our criteria we would exclude record IDs:

  • VUSM: 23, 26, 39, 40, 54, 3, 8, 12, 49, 60, 62, 64

  • HMS: 1, 21, 28, 30, 34, 37, 39, 41, 44, 47, 49, 61

  • UVA: 33, 47, 80, 81, 83

[1] "uworld_percent_step1_1" "uworld_percent_step1_2"
[1] "amboss_percent_step1_1" "amboss_percent_step1_2"
[1] "length_step1_1" "length_step1_2"
[1] "practicetest_step1_1" "practicetest_step1_2"
[1] "full_test_practice_step1_1" "full_test_practice_step1_2"
[1] "push_step1_1" "push_step1_2"
[1] "push_practice_test_step1_1" "push_practice_test_step1_2"
[1] "push_nbme_practice_score_step1_1" "push_nbme_practice_score_step1_2"
[1] "push_uw_practice_score_step1_1" "push_uw_practice_score_step1_2"
[1] "final_nbme_practice_score_step1_1" "final_nbme_practice_score_step1_2"
[1] "final_uw_practice_score_step1_1" "final_uw_practice_score_step1_2"
[1] "score_step1_1" "score_step1_2"
[1] "other_resources_step1_1" "other_resources_step1_2"
[1] "other_step1_1" "other_step1_2"
[1] "changes_step1_1" "changes_step1_2"
[1] "Above is a list of columns I have combined for you. Hope it looks right!"
[1] "uworld_percent_step2_1" "uworld_percent_step2_2"
[1] "amboss_percent_step2_1" "amboss_percent_step2_2"
[1] "length_step2_1" "length_step2_2"
[1] "practicetest_step2_1" "practicetest_step2_2"
[1] "full_test_practice_step2_1" "full_test_practice_step2_2"
[1] "practice_score_step2_1" "practice_score_step2_2"
[1] "practice_test_step2_1" "practice_test_step2_2"
[1] "score_step2_1" "score_step2_2"
[1] "target_score_step2_1" "target_score_step2_2"
[1] "Above is a list of columns I have combined for you. Hope it looks right!"

There were 203 participants after the the clients did data exclusion by hand, as compared to the total survey size which was 182 unique individuals included in the step 1 data.

These are the record IDs that were excluded by the collaborator: VUSM 23, VUSM 60, HMS 37, HMS 41, HMS 49, UVASOM 33, UVASOM 80, UVASOM 84.

For our analysis, I originally included everyone from the 3 school specific data sets. Then, we flagged individuals to remove and I remade the source data set. These are the records IDs that we decided to exclude:

  • VU record ids: 23, 26, 39, 40, 54, 3, 8, 12, 49, 60, 62, 64

  • HMS record ids: 1, 21, 28, 30, 34, 37, 39, 41, 44, 47, 49, 61

  • UVA record ids: 33, 47, 80, 81, 83

Below are tables for Step 1 and Step 2 response inclusion by school:

Code
kable(table(step1_complete$schoolid), caption = "Number of Step 1 responses included by school")
Number of Step 1 responses included by school
Var1 Freq
HMS 50
UVa 79
VU 53
Code
kable(table(step2_complete$schoolid), caption = "Number of Step 2 responses included by school")
Number of Step 2 responses included by school
Var1 Freq
HMS 39
UVa 65
VU 34

Notice that unfortunately for Step 2 analysis, we had to drop 44 individuals who did not report a step 2 score. These raw counts and frequencies of people who did not give a step 2 score (and are therefor not eligible for analysis) are listed by institution below.

Code
# describing the missingness
kable(table(drop_these_with_no_outcome$schoolid), caption = "Number of missing Step 2 scores by institution")
Number of missing Step 2 scores by institution
Var1 Freq
HMS 11
UVa 14
VU 19
Code
num <- as.vector(table(drop_these_with_no_outcome$schoolid))
denom <- as.vector(table(step2_complete$schoolid))
nonresponse_freq <- setNames(c(round(num/denom, 3)), c(names(table(step2_complete$schoolid))))
kable(nonresponse_freq, caption = "frequency of missing step 2 scores by instition")
frequency of missing step 2 scores by instition
x
HMS 0.282
UVa 0.215
VU 0.559

We also find it helpful to visually profile the missingness in this graphic below. Some of this missingness is due to questions being hierarchical.

Code
######### visually profile missing responses
p1 <- visdat::vis_miss(step1_complete)
p2 <- visdat::vis_miss(step2_complete)

title_gg <- ggdraw() + draw_label("Response missingness for pooled survey results across exam order")
gridded <- plot_grid(p1, p2, label_size = 12, ncol = 2, align = "hv", label_x = 0.5,
          labels = c("Step 1","Step 2"))
plot_grid(title_gg, gridded, nrow = 2, rel_heights = c(0.1, 0.9))

2 Analysis

Note, we plan to use the robust/sandwich variance estimator for regression models. One inclusion criteria is that the outcome variable (“Y”) must be available for a subject to be included in the analysis question (ie. if they did not report a step 2 score, we won’t perform relevant step 2 analysis on them).

We cannot analyze Step 1 since all survey responses reported passing For Step 2 scores, I will perform a linear regression with:

  • Y = Step 2 score
  • X = factor ( 1 = “step 1 first”, 2 = “step 2 first”, 3 = “only step 1”, 4 = “only step 2”)
  • Z = school (need to adjust for this)
Code
step2_complete[ ,"order_factor"]  <- factor(step2_complete$exam_order, levels = c(1,2, 3, 4), labels = c("step 1 first", "step 2 first", "only step 1", "only step 2"))

step2_complete[ ,"which_exam_first"] <- ifelse(step2_complete$order_factor == "step 1 first" | step2_complete$order_factor == "only step 1", 1, 2)

step2_complete[ ,"school_factor"]   <- factor(step2_complete$schoolid, labels = c("HMS", "UVA", "VUMS"))

table(step2_complete$order_factor)

step 1 first step 2 first  only step 1  only step 2 
          71           67            0            0 
Code
table(step2_complete$which_exam_first)

 1  2 
71 67 
Code
exam_order_mod <- lm(formula = score_step2 ~ which_exam_first + school_factor, data = step2_complete)
sandwich(exam_order_mod) #this gives the sandwich variance
                  (Intercept) which_exam_first school_factorUVA
(Intercept)         15.312108       -11.102169         4.924963
which_exam_first   -11.102169        10.495092        -7.995276
school_factorUVA     4.924963        -7.995276        14.443649
school_factorVUMS   -1.980325        -1.508644         4.717851
                  school_factorVUMS
(Intercept)               -1.980325
which_exam_first          -1.508644
school_factorUVA           4.717851
school_factorVUMS          5.933156
Code
summary(exam_order_mod) #model summary for reporting

Call:
lm(formula = score_step2 ~ which_exam_first + school_factor, 
    data = step2_complete)

Residuals:
     Min       1Q   Median       3Q      Max 
-112.100   -5.178    2.767    8.761   21.900 

Coefficients:
                  Estimate Std. Error t value Pr(>|t|)    
(Intercept)       261.3383     5.2033  50.225   <2e-16 ***
which_exam_first    0.8952     4.5256   0.198    0.844    
school_factorUVA   -4.0290     5.0342  -0.800    0.425    
school_factorVUMS  -0.9797     3.5128  -0.279    0.781    
---
Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1

Residual standard error: 14.69 on 134 degrees of freedom
Multiple R-squared:  0.01018,   Adjusted R-squared:  -0.01198 
F-statistic: 0.4593 on 3 and 134 DF,  p-value: 0.7112

Based on the model output (p values), there doesn’t appear to be any signifigant associations between exam order and the score for Step 2. Since the R^2 value is essentially 0, I conclude that there was no effect of exam order on step 2 scores.

Again, we cannot analyze Step 1 scores since all respondents reported passing.

Based on our SAP, if there are any covariates with more than 30% of responses missing, we will drop that variable or populate it with 0, depending on context. For example, the percent of Amboss questions completed will be filled with 0 for people who didn’t answer that they used Amboss since it seems safe to assume they didn’t complete any of the Amboss questions. For people who did select that they used Amboss but didn’t answer a percentage will be treated as missing

If less than 30% are missing, I may consider performing bootstrap sampling of known values to replace missing values.

After accounting for missingness, I will assess for co-linearity of the predictors (ie. correlation) using VIF. If there is high co-linearity, we will use LASSO to perform variable selection. If there is no evidence of concerning levels of colinearity, I will proceed with linear regression.

Code
#here I am creating the cleaned Uworld and Amboss variables. if they did not check that they used it, the percentage is set to 0.
# if they did use it then the next ifelse checks if there is an NA where there should be a percent
# if there is an NA where there should be a percent, we maintain this NA. If there is not, then we can report the percentage.
# same process for uworld
step2_complete <- step2_complete %>% mutate(amboss_clean = ifelse(I.amboss == 0, 0, 
                                    ifelse(is.na(step2_complete$amboss_percent_step2) == TRUE, NA, step2_complete$amboss_percent_step2)),
                                    
                                    uworld_clean = ifelse(I.uworld == 0, 0, 
                                    ifelse(is.na(step2_complete$uworld_percent_step2 ) == TRUE, NA, step2_complete$uworld_percent_step2)))

#inspecting percent missing, it seems like most responses are now complete enough for analysis
step2_complete$amboss_percent_step2 <- ifelse(is.na(step2_complete$amboss_percent_step2) == TRUE, 0, step2_complete$amboss_percent_step2)
class(step2_complete$practicetest_step2) <- "integer"

step2_complete[,"on_target"] <-  factor(step2_complete$target_score_step2, levels = c(1,2,3), labels = c("at target", "above target", "below target"))


# I looked into the difference between practice_test_step2 (the final practice test I took before my exam was... 8 options) and practicetest_step2 (text response of how many practice tests did you take before step 2).
# I decided to use practicetest_step2 (text response of how many practice tests did you take before step 2) but extract and recode it as numeric below
step2_complete[, "practice_test_2_clean"] <- ifelse(is.na(step2_complete$practicetest_step2) == TRUE, NA, substr(step2_complete$practicetest_step2, start = 1, stop = 1))
step2_complete[, "number_of_practice_tests"] <- as.numeric(step2_complete$practice_test_2_clean) #I want to include the number of practice tests as just one numeric covariate, not coded as a factor like it is in practice_test_2_clean

step2_complete$full_practice_test <- factor(step2_complete$full_test_practice_step2 , levels = c(1:4), labels = c("Yes and I'm glad I did", "Yes and it was unnecessary", "No and I wish I did", "No and I'm glad I did not"))
step2_complete$simulate_full_practice <- ifelse(step2_complete$full_test_practice_step2 <= 2, 1, 0)
step2_complete$simulate_full_practice <- factor(step2_complete$simulate_full_practice, levels = c(0, 1), labels = c("No", "Yes"))
step2_complete$length_step2 <- factor(step2_complete$length_step2 , levels = c(1:6), labels = c("less than 1 week", "1-2 weeks", "3-4 weeks", "5-6 weeks", "7-8 weeks", "more than 8 weeks"))


######## profile missingness in the step 2 data and address
step2_profile <- step2_complete %>% relocate(c(score_step2, uworld_clean, amboss_clean, length_step2, simulate_full_practice, practice_score_step2, number_of_practice_tests, school_factor), .before = schoolid)

percents_missing <-round(colSums(is.na(step2_profile))/nrow(step2_profile), 3)*100
kable(percents_missing, caption = "Percent missing observations for pooled Step 2 survey")
Percent missing observations for pooled Step 2 survey
x
record_id 0.0
score_step2 0.0
uworld_clean 1.4
amboss_clean 9.4
length_step2 1.4
simulate_full_practice 0.0
practice_score_step2 29.7
number_of_practice_tests 5.1
school_factor 0.0
schoolid 0.0
exam_order 0.0
uworld_percent_step2 1.4
amboss_percent_step2 0.0
practicetest_step2 5.1
full_test_practice_step2 0.0
practice_test_step2 29.0
target_score_step2 0.0
I.uworld 0.0
I.firstaid 0.0
I.anki 0.0
I.sketchy 0.0
I.amboss 0.0
I.pathoma 0.0
I.boardsbeyond 0.0
I.other 0.0
order_factor 0.0
which_exam_first 0.0
on_target 0.0
practice_test_2_clean 5.1
full_practice_test 0.0

Multiple linear regression with:

  • Y = Step 2 score (from “What was your 3-digit score on the official Step 2 exam?”)

  • X1 = % UWorld (recoded from “Approximately what % of UWorld did you complete during your protected study period for step 2?”)

  • X2 = % Amboss (recoded from “Approximately what % of the Amboss question bank did you complete during your Step 2 protected study period?”)

  • X3 = length study (factor from “How long did you study for Step 2 during a protected study period?”)

  • X4 = # of practice tests (recoded from a text answer from “How many total practice tests did you take before Step 2?”)

  • X5 = full test day (yes/no code as binary from “Did you simulate a full Step 2 test day experience, e.g. 8 blocks of 40 UWorld questions or 2 of the 4-section practice tests?”)

  • X6 = final practice score (What was your 3 digit score on the final practice test you took before the Step 2 exam?)

  • Z = School (need to adjust for this in order to remove any influence)

Careful to note that not all cases are complete - for example there are 399 responses in the complete step 2 dataset, of which for the number of practice tests taken, 108 are missing and 291 have a response recorded.

Below I report the model results, sandwich variance, and VIF for step 2 scores model. After that, I show descriptive statistics for predictors and the outcome that was included in the model.

Code
mod_step2_scores <- lm(score_step2 ~ uworld_clean + amboss_clean + length_step2 + simulate_full_practice + practice_score_step2 + number_of_practice_tests + school_factor, data = step2_complete) 
summary(mod_step2_scores)

Call:
lm(formula = score_step2 ~ uworld_clean + amboss_clean + length_step2 + 
    simulate_full_practice + practice_score_step2 + number_of_practice_tests + 
    school_factor, data = step2_complete)

Residuals:
    Min      1Q  Median      3Q     Max 
-21.360  -3.463   1.966   5.068  15.498 

Coefficients:
                                Estimate Std. Error t value Pr(>|t|)    
(Intercept)                   111.950778  18.543622   6.037 6.22e-08 ***
uworld_clean                    0.003943   0.044241   0.089   0.9292    
amboss_clean                    0.041176   0.042959   0.959   0.3410    
length_step25-6 weeks           1.930819   2.221260   0.869   0.3876    
length_step27-8 weeks          -4.190772   2.771947  -1.512   0.1349    
length_step2more than 8 weeks  -7.817921   6.423664  -1.217   0.2276    
simulate_full_practiceYes       0.410541   2.165465   0.190   0.8502    
practice_score_step2            0.599139   0.071590   8.369 3.14e-12 ***
number_of_practice_tests       -1.156330   0.672732  -1.719   0.0899 .  
school_factorUVA                0.845109   2.534346   0.333   0.7398    
school_factorVUMS              -1.417165   2.459452  -0.576   0.5663    
---
Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1

Residual standard error: 8.204 on 72 degrees of freedom
  (55 observations deleted due to missingness)
Multiple R-squared:  0.5603,    Adjusted R-squared:  0.4992 
F-statistic: 9.174 on 10 and 72 DF,  p-value: 1.401e-09
Code
sandwich(mod_step2_scores)
                               (Intercept)  uworld_clean  amboss_clean
(Intercept)                   340.41118113 -0.0783352214  0.1696981274
uworld_clean                   -0.07833522  0.0011037779  0.0001622475
amboss_clean                    0.16969813  0.0001622475  0.0010885950
length_step25-6 weeks          -1.73083732  0.0036043139 -0.0021614635
length_step27-8 weeks          -2.77583465  0.0234623553  0.0010957333
length_step2more than 8 weeks   0.13362159 -0.0150723533  0.0350055231
simulate_full_practiceYes       7.36295833 -0.0171304514 -0.0007170592
practice_score_step2           -1.21531124 -0.0002017563 -0.0006727492
number_of_practice_tests       -1.93388529  0.0058264396 -0.0034664273
school_factorUVA              -21.61708719  0.0270290610 -0.0257822808
school_factorVUMS             -14.59580072  0.0152415741  0.0048932951
                              length_step25-6 weeks length_step27-8 weeks
(Intercept)                            -1.730837323          -2.775834646
uworld_clean                            0.003604314           0.023462355
amboss_clean                           -0.002161464           0.001095733
length_step25-6 weeks                   3.150662734           1.835473954
length_step27-8 weeks                   1.835473954           6.149906734
length_step2more than 8 weeks           1.290245222           1.274612466
simulate_full_practiceYes               0.410599462          -0.066836678
practice_score_step2                   -0.001350060          -0.005486582
number_of_practice_tests               -0.087789974          -0.063694975
school_factorUVA                        0.626140189           1.314482146
school_factorVUMS                       0.456557913           1.227766263
                              length_step2more than 8 weeks
(Intercept)                                      0.13362159
uworld_clean                                    -0.01507235
amboss_clean                                     0.03500552
length_step25-6 weeks                            1.29024522
length_step27-8 weeks                            1.27461247
length_step2more than 8 weeks                  126.15644668
simulate_full_practiceYes                       -1.83397059
practice_score_step2                             0.01240497
number_of_practice_tests                        -0.66288672
school_factorUVA                                -1.87152051
school_factorVUMS                                0.38067455
                              simulate_full_practiceYes practice_score_step2
(Intercept)                                7.3629583303        -1.2153112380
uworld_clean                              -0.0171304514        -0.0002017563
amboss_clean                              -0.0007170592        -0.0006727492
length_step25-6 weeks                      0.4105994618        -0.0013500601
length_step27-8 weeks                     -0.0668366777        -0.0054865823
length_step2more than 8 weeks             -1.8339705896         0.0124049677
simulate_full_practiceYes                  4.1076618930        -0.0225018643
practice_score_step2                      -0.0225018643         0.0046587629
number_of_practice_tests                  -0.1453023272         0.0009702705
school_factorUVA                          -1.5115492653         0.0604174269
school_factorVUMS                         -0.5325305293         0.0388873822
                              number_of_practice_tests school_factorUVA
(Intercept)                              -1.9338852900     -21.61708719
uworld_clean                              0.0058264396       0.02702906
amboss_clean                             -0.0034664273      -0.02578228
length_step25-6 weeks                    -0.0877899742       0.62614019
length_step27-8 weeks                    -0.0636949754       1.31448215
length_step2more than 8 weeks            -0.6628867246      -1.87152051
simulate_full_practiceYes                -0.1453023272      -1.51154927
practice_score_step2                      0.0009702705       0.06041743
number_of_practice_tests                  0.2744033199       0.20364601
school_factorUVA                          0.2036460086       6.05601479
school_factorVUMS                         0.1089025371       2.88708848
                              school_factorVUMS
(Intercept)                       -14.595800716
uworld_clean                        0.015241574
amboss_clean                        0.004893295
length_step25-6 weeks               0.456557913
length_step27-8 weeks               1.227766263
length_step2more than 8 weeks       0.380674551
simulate_full_practiceYes          -0.532530529
practice_score_step2                0.038887382
number_of_practice_tests            0.108902537
school_factorUVA                    2.887088480
school_factorVUMS                   4.279247727
Code
vif(mod_step2_scores)
                 uworld_clean                  amboss_clean 
                     1.227399                      1.236755 
        length_step25-6 weeks         length_step27-8 weeks 
                     1.503404                      1.609434 
length_step2more than 8 weeks     simulate_full_practiceYes 
                     1.196735                      1.188729 
         practice_score_step2      number_of_practice_tests 
                     1.163156                      1.221483 
             school_factorUVA             school_factorVUMS 
                     1.828295                      1.570226 
Code
mod_step2_scores %>% tbl_regression() #this makes a cleaner looking summary table
Characteristic Beta 95% CI1 p-value
uworld_clean 0.00 -0.08, 0.09 >0.9
amboss_clean 0.04 -0.04, 0.13 0.3
length_step2


    3-4 weeks
    5-6 weeks 1.9 -2.5, 6.4 0.4
    7-8 weeks -4.2 -9.7, 1.3 0.13
    more than 8 weeks -7.8 -21, 5.0 0.2
simulate_full_practice


    No
    Yes 0.41 -3.9, 4.7 0.9
practice_score_step2 0.60 0.46, 0.74 <0.001
number_of_practice_tests -1.2 -2.5, 0.18 0.090
school_factor


    HMS
    UVA 0.85 -4.2, 5.9 0.7
    VUMS -1.4 -6.3, 3.5 0.6
1 CI = Confidence Interval

Trying the model with imputation, but there is an issue right now with just imputing one value instead of randomly sampling…

Note

imputation needs to be fixed before interpreting this model! see the snippet of the updated data showing this issue

Code
#following this thought process for the variables that had missingness for the 2nd model
# df %>% mutate(var = ifelse(!is.na(var),var, sample(var[!is.na(var)],1)))
# as described on this blog https://community.rstudio.com/t/replacing-nas-with-random-values-from-a-set/158833/2 
## model variables were uworld_clean + amboss_clean + length_step2 + simulate_full_practice + practice_score_step2 + number_of_practice_tests + school_factor
# with missingness in uworld_clean, amboss_clean, length_step2, practice_score_step2, and number_of_practice_tests

step2_impute <-
  step2_complete %>% select(
    score_step2,
    uworld_clean,
    amboss_clean,
    length_step2,
    simulate_full_practice,
    practice_score_step2,
    number_of_practice_tests,
    school_factor
  ) %>%     mutate(uworld = ifelse(!is.na(uworld_clean), uworld_clean, sample(uworld_clean[!is.na(uworld_clean)], 1)),
                   amboss = ifelse(!is.na(amboss_clean), amboss_clean, sample(amboss_clean[!is.na(amboss_clean)], 1)),
                   length = factor(ifelse(!is.na(length_step2), length_step2, sample(length_step2[!is.na(length_step2)], 1)), levels = c(1:6), labels = c("less than 1 week", "1-2 weeks", "3-4 weeks", "5-6 weeks", "7-8 weeks", "more than 8 weeks")),
                   prac_score = ifelse(!is.na(practice_score_step2), practice_score_step2, sample(practice_score_step2[!is.na(practice_score_step2)], 1)),
                   num_tests = ifelse(!is.na(number_of_practice_tests), number_of_practice_tests, sample(number_of_practice_tests[!is.na(number_of_practice_tests)], 1))  
                   )

colSums(is.na(step2_impute)) #to confirm the random sampling replacement worked
             score_step2             uworld_clean             amboss_clean 
                       0                        2                       13 
            length_step2   simulate_full_practice     practice_score_step2 
                       2                        0                       41 
number_of_practice_tests            school_factor                   uworld 
                       7                        0                        0 
                  amboss                   length               prac_score 
                       0                        0                        0 
               num_tests 
                       0 
Code
#here is a view of one change:
# cbind(step2_impute$length_step2, step2_impute$length)
cbind(step2_impute$practice_score_step2, step2_impute$prac_score)[1:22,]
      [,1] [,2]
 [1,]  266  266
 [2,]  251  251
 [3,]  260  260
 [4,]   NA  283
 [5,]  250  250
 [6,]  269  269
 [7,]  249  249
 [8,]  259  259
 [9,]  230  230
[10,]  237  237
[11,]  258  258
[12,]  265  265
[13,]  256  256
[14,]   NA  283
[15,]   NA  283
[16,]  273  273
[17,]   NA  283
[18,]  268  268
[19,]  274  274
[20,]   NA  283
[21,]  245  245
[22,]  247  247
Code
mod_impute_step2_scores <- lm(score_step2 ~ uworld + amboss + length + simulate_full_practice + prac_score + num_tests + school_factor, data = step2_impute) 
summary(mod_impute_step2_scores)

Call:
lm(formula = score_step2 ~ uworld + amboss + length + simulate_full_practice + 
    prac_score + num_tests + school_factor, data = step2_impute)

Residuals:
    Min      1Q  Median      3Q     Max 
-38.559  -5.567   1.705   6.004  35.388 

Coefficients:
                           Estimate Std. Error t value Pr(>|t|)    
(Intercept)               125.16650   18.06967   6.927 1.97e-10 ***
uworld                      0.02155    0.04259   0.506   0.6138    
amboss                      0.06674    0.04167   1.602   0.1117    
length3-4 weeks            26.19024   11.13264   2.353   0.0202 *  
length5-6 weeks            25.55568   11.20114   2.282   0.0242 *  
length7-8 weeks            23.51977   11.39961   2.063   0.0411 *  
lengthmore than 8 weeks    -0.19995   13.26028  -0.015   0.9880    
simulate_full_practiceYes   1.39171    2.03616   0.683   0.4955    
prac_score                  0.41314    0.05199   7.947 9.27e-13 ***
num_tests                   0.08799    0.65235   0.135   0.8929    
school_factorUVA           -2.91354    2.49284  -1.169   0.2447    
school_factorVUMS          -0.61790    2.61135  -0.237   0.8133    
---
Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1

Residual standard error: 10.46 on 126 degrees of freedom
Multiple R-squared:  0.5276,    Adjusted R-squared:  0.4863 
F-statistic: 12.79 on 11 and 126 DF,  p-value: 5.277e-16
Code
sandwich(mod_impute_step2_scores)
                           (Intercept)        uworld        amboss
(Intercept)               641.75111552 -5.209391e-02  2.315300e-01
uworld                     -0.05209391  1.089057e-03 -2.654337e-05
amboss                      0.23152997 -2.654337e-05  1.192035e-03
length3-4 weeks           -31.22807393 -7.546567e-02 -3.074641e-02
length5-6 weeks           -42.34250155 -7.925879e-02 -4.470312e-02
length7-8 weeks           -46.40223631 -6.256000e-02 -4.794222e-02
lengthmore than 8 weeks   -36.28205834 -1.038884e-02  1.237317e-02
simulate_full_practiceYes  -9.53443998 -3.084039e-03 -1.098783e-02
prac_score                 -2.15978269  6.141168e-05 -7.158214e-04
num_tests                  -4.15572069  3.367647e-03 -1.558785e-03
school_factorUVA           -8.11426061  1.898305e-02 -1.307598e-02
school_factorVUMS         -14.59214415  1.517308e-02  5.770524e-03
                          length3-4 weeks length5-6 weeks length7-8 weeks
(Intercept)                  -31.22807393    -42.34250155    -46.40223631
uworld                        -0.07546567     -0.07925879     -0.06256000
amboss                        -0.03074641     -0.04470312     -0.04794222
length3-4 weeks               10.35399791     10.88621415      9.71060647
length5-6 weeks               10.88621415     15.13804410     12.54658278
length7-8 weeks                9.71060647     12.54658278     15.57077552
lengthmore than 8 weeks       -2.46666683     -0.85767947     -3.88492120
simulate_full_practiceYes      2.65299169      2.84026369      2.64943079
prac_score                     0.10704355      0.14416164      0.15557051
num_tests                     -0.24925436     -0.54824935     -0.44437717
school_factorUVA              -0.36675438      0.98331291      1.55996300
school_factorVUMS             -1.24361970     -0.01176503      0.50122979
                          lengthmore than 8 weeks simulate_full_practiceYes
(Intercept)                          -36.28205834              -9.534439983
uworld                                -0.01038884              -0.003084039
amboss                                 0.01237317              -0.010987833
length3-4 weeks                       -2.46666683               2.652991688
length5-6 weeks                       -0.85767947               2.840263687
length7-8 weeks                       -3.88492120               2.649430793
lengthmore than 8 weeks              272.92517181              -4.089818112
simulate_full_practiceYes             -4.08981811               3.361292912
prac_score                             0.12106838               0.023582777
num_tests                              1.61190077               0.093107383
school_factorUVA                       1.35693259              -0.755428624
school_factorVUMS                      1.47869674              -0.749283926
                             prac_score    num_tests school_factorUVA
(Intercept)               -2.159783e+00 -4.155720689      -8.11426061
uworld                     6.141168e-05  0.003367647       0.01898305
amboss                    -7.158214e-04 -0.001558785      -0.01307598
length3-4 weeks            1.070436e-01 -0.249254357      -0.36675438
length5-6 weeks            1.441616e-01 -0.548249349       0.98331291
length7-8 weeks            1.555705e-01 -0.444377174       1.55996300
lengthmore than 8 weeks    1.210684e-01  1.611900770       1.35693259
simulate_full_practiceYes  2.358278e-02  0.093107383      -0.75542862
prac_score                 7.379949e-03  0.011218705       0.01352689
num_tests                  1.121870e-02  0.270561326       0.04909478
school_factorUVA           1.352689e-02  0.049094776       4.74243011
school_factorVUMS          4.382131e-02 -0.036727464       2.92879469
                          school_factorVUMS
(Intercept)                   -14.592144149
uworld                          0.015173083
amboss                          0.005770524
length3-4 weeks                -1.243619696
length5-6 weeks                -0.011765027
length7-8 weeks                 0.501229793
lengthmore than 8 weeks         1.478696744
simulate_full_practiceYes      -0.749283926
prac_score                      0.043821311
num_tests                      -0.036727464
school_factorUVA                2.928794692
school_factorVUMS               4.884227549
Code
vif(mod_impute_step2_scores)
                   uworld                    amboss           length3-4 weeks 
                 1.224372                  1.078084                 37.448628 
          length5-6 weeks           length7-8 weeks   lengthmore than 8 weeks 
                37.910894                 23.533960                  4.713673 
simulate_full_practiceYes                prac_score                 num_tests 
                 1.148467                  1.243570                  1.142773 
         school_factorUVA         school_factorVUMS 
                 1.951748                  1.596030 
Code
mod_impute_step2_scores %>% tbl_regression() #this makes a cleaner looking summary table
Characteristic Beta 95% CI1 p-value
uworld 0.02 -0.06, 0.11 0.6
amboss 0.07 -0.02, 0.15 0.11
length


    1-2 weeks
    3-4 weeks 26 4.2, 48 0.020
    5-6 weeks 26 3.4, 48 0.024
    7-8 weeks 24 0.96, 46 0.041
    more than 8 weeks -0.20 -26, 26 >0.9
simulate_full_practice


    No
    Yes 1.4 -2.6, 5.4 0.5
prac_score 0.41 0.31, 0.52 <0.001
num_tests 0.09 -1.2, 1.4 0.9
school_factor


    HMS
    UVA -2.9 -7.8, 2.0 0.2
    VUMS -0.62 -5.8, 4.5 0.8
1 CI = Confidence Interval

Here, I will perform logistic regression with

Y = yes or no (1 = yes, 2 = no for “push_step1”)

There may not be sufficient data on this since only 20 people responded that they decided to push back Step 1. The factors that were measured are:

  • push remember step1 (1 = I only remember the form name, 2 = I only remember the score, 3 = I remember the form name and the score, 4 = I don’t remember either) - we decided not to include this variable (can change later if desired)

  • push score only step 1 (1 = NBME, 2 = Uworld)

  • push practice test step 1 ( 1 - 8 listing various exams)

  • push nbme practice score (from 0 to 100%)

  • push uw practice score (from 180 to 300)

Listing variables by name and if I have included them:

  • “push_step1_1” yes

  • “push_remember_step1_1” not included b/c a precursor question

  • “push_score_only_step1_1” not currently included but could be

  • “push_practice_test_step1_1” yes

  • “push_nbme_practice_score_step1_1” yes

  • “push_uw_practice_score_step1_1” yes

Code
step1_complete$push_step1 <- ifelse(step1_complete$push_step1 == 2 | is.na(step1_complete$push_step1) ==TRUE, 2, 1) #recording the NA's to be "No" (they did not push back step 1)
step1_complete$push_step1_label <- factor(step1_complete$push_step1, levels = c(1, 2), labels = c("Yes", "No")) #making a nice descriptive label

did_push_df <- step1_complete %>% filter(push_step1_label == "Yes")
dat %>% filter(!is.na(push_remember_step1_1))
     X record_id school           timestamp year exam_order step_spacing
1    9         7   VUSM         2/8/23 9:31    3          1            2
2   12        12   VUSM        2/8/23 10:05    5          1            1
3   23        39   VUSM       2/16/23 20:12    6          1            3
4   29        51   VUSM       2/20/23 12:57    3          1            3
5   47         9   VUSM         2/8/23 9:53    3          3            3
6   50        20   VUSM        2/8/23 11:05    3          1            3
7   60        57   VUSM       2/21/23 10:19    3          3            3
8   75        12 UVASOM 2023-08-17 11:31:21    7          1            2
9  129        67 UVASOM 2023-09-07 09:48:22    7          1            2
10 141        79 UVASOM 2023-09-07 16:02:17    7          1            2
11 174        30    HMS 2023-08-23 18:50:56    4          3            2
12 196        55    HMS 2023-10-04 08:31:07    7          1            2
13 199        58    HMS 2023-10-04 15:27:27    7          1            2
   step_spacing_months survey_complete step_1_first_timestamp
1                   NA               2            2/8/23 9:33
2                   NA               2           2/8/23 10:11
3                    5               2          2/16/23 20:14
4                    3               2          2/20/23 12:59
5                    7               2            2/8/23 9:56
6                    5               2           2/8/23 11:19
7                    6               2          2/21/23 10:26
8                   NA               2    2023-08-17 11:32:55
9                   NA               2    2023-09-07 09:49:48
10                  NA               2    2023-09-07 16:04:58
11                  NA               2    2023-08-23 19:10:48
12                  NA               2    2023-10-04 08:37:24
13                  NA               2    2023-10-04 15:29:01
   resources_step1_1___1 resources_step1_1___2 resources_step1_1___3
1                      1                     1                     0
2                      1                     1                     1
3                      1                     1                     1
4                      1                     1                     1
5                      1                     1                     0
6                      1                     1                     1
7                      0                     0                     1
8                      1                     1                     1
9                      1                     1                     0
10                     1                     1                     0
11                     1                     1                     0
12                     1                     1                     1
13                     1                     1                     0
   resources_step1_1___4 resources_step1_1___5 resources_step1_1___6
1                      0                     0                     0
2                      1                     0                     0
3                      1                     0                     1
4                      1                     0                     1
5                      1                     0                     0
6                      1                     0                     0
7                      1                     0                     0
8                      0                     1                     0
9                      0                     0                     0
10                     0                     0                     0
11                     1                     0                     0
12                     1                     1                     1
13                     0                     0                     0
   resources_step1_1___7 resources_step1_1___8 other_resources_step1_1
1                      0                     0                    <NA>
2                      0                     0                    <NA>
3                      1                     0                    <NA>
4                      0                     0                    <NA>
5                      0                     0                    <NA>
6                      0                     0                    <NA>
7                      0                     0                    <NA>
8                      0                     0                    <NA>
9                      0                     0                    <NA>
10                     0                     0                    <NA>
11                     0                     1                 Osmosis
12                     1                     0                        
13                     0                     0                        
   other_step1_1 uworld_percent_step1_1 uworld_step1_1 first_aid_step1_1
1           <NA>                     NA              3                 1
2           <NA>                     60              3                 1
3           <NA>                     80              1                 1
4           <NA>                     65              1                 1
5           <NA>                     50              1                 1
6           <NA>                     69              1                 1
7           <NA>                     NA             NA                NA
8           <NA>                     75              1                 1
9           <NA>                     70              3                 2
10          <NA>                     35              3                 1
11           Yes                     30              3                 2
12                                   90              3                 1
13                                   86              1                 1
   anki_step1_1 anki_use_step1_1 anki_details_step1_1___1
1            NA               NA                        0
2             1                1                        0
3             1                3                        0
4             1                3                        1
5            NA               NA                        0
6             1                1                        1
7             1                3                        1
8             1                1                        0
9            NA               NA                        0
10           NA               NA                        0
11           NA               NA                        0
12            1                3                        0
13           NA               NA                        0
   anki_details_step1_1___2 anki_details_step1_1___3 anki_details_step1_1___4
1                         0                        0                        0
2                         0                        1                        0
3                         1                        0                        0
4                         0                        0                        0
5                         0                        0                        0
6                         0                        0                        0
7                         0                        0                        0
8                         0                        1                        0
9                         0                        0                        0
10                        0                        0                        0
11                        0                        0                        0
12                        0                        1                        0
13                        0                        0                        0
   anki_details_step1_1___5 anki_details_step1_1___6 anki_details_step1_1___7
1                         0                        0                        0
2                         0                        1                        0
3                         0                        1                        0
4                         0                        1                        0
5                         0                        0                        0
6                         0                        0                        1
7                         1                        1                        0
8                         0                        0                        0
9                         0                        0                        0
10                        0                        0                        0
11                        0                        0                        0
12                        0                        1                        0
13                        0                        0                        0
   sketchy_step1_1 sketchy_details_step1_1___1 sketchy_details_step1_1___2
1               NA                           0                           0
2                1                           1                           1
3                1                           1                           1
4                1                           1                           1
5                1                           1                           1
6                1                           0                           1
7                1                           1                           1
8               NA                           0                           0
9               NA                           0                           0
10              NA                           0                           0
11               1                           0                           0
12               1                           1                           1
13              NA                           0                           0
   sketchy_details_step1_1___3 sketchy_details_step1_1___4
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           0                           0
13                           0                           0
   sketchy_details_step1_1___5 sketchy_details_step1_1___6
1                            0                           0
2                            0                           1
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           1
8                            0                           0
9                            0                           0
10                           0                           0
11                           1                           0
12                           0                           1
13                           0                           0
   sketchy_details_step1_1___7 amboss_details_step1_1___1
1                            0                          0
2                            0                          0
3                            0                          0
4                            0                          0
5                            0                          0
6                            0                          0
7                            0                          0
8                            0                          0
9                            0                          0
10                           0                          0
11                           0                          0
12                           0                          0
13                           0                          0
   amboss_details_step1_1___2 amboss_details_step1_1___3 amboss_library_step1_1
1                           0                          0                     NA
2                           0                          0                     NA
3                           0                          0                     NA
4                           0                          0                     NA
5                           0                          0                     NA
6                           0                          0                     NA
7                           0                          0                     NA
8                           1                          0                      1
9                           0                          0                     NA
10                          0                          0                     NA
11                          0                          0                     NA
12                          0                          1                      1
13                          0                          0                     NA
   amboss_percent_step1_1 amboss_amount_step1_1 pathoma_step1_1 bnb_step1_1
1                      NA                    NA              NA          NA
2                      NA                    NA              NA          NA
3                      NA                    NA               1           1
4                      NA                    NA               1          NA
5                      NA                    NA              NA          NA
6                      NA                    NA              NA          NA
7                      NA                    NA              NA          NA
8                      NA                    NA              NA          NA
9                      NA                    NA              NA          NA
10                     NA                    NA              NA          NA
11                     NA                    NA              NA          NA
12                     32                     3               1           1
13                     NA                    NA              NA          NA
   bnb_how_step1_1___1 bnb_how_step1_1___2 bnb_how_step1_1___3
1                    0                   0                   0
2                    0                   0                   0
3                    1                   0                   0
4                    0                   0                   0
5                    0                   0                   0
6                    0                   0                   0
7                    0                   0                   0
8                    0                   0                   0
9                    0                   0                   0
10                   0                   0                   0
11                   0                   0                   0
12                   1                   0                   0
13                   0                   0                   0
   bnb_how_step1_1___4 length_step1_1 practicetest_step1_1
1                    0              4                    4
2                    0              3                    3
3                    0              6                    6
4                    0              4                    4
5                    0              3                    5
6                    0              6                    6
7                    0              6                    5
8                    0              4                    4
9                    0              4                    3
10                   0              4                    3
11                   0              3                    4
12                   0              5                    3
13                   0              5                    5
   practice_test_amount_step1_1 full_test_practice_step1_1 push_step1_1
1                             3                          2            1
2                             3                          1            1
3                             2                          4            1
4                             1                          3            1
5                             3                          1            1
6                             3                          3            1
7                             3                          4            1
8                             3                          3            1
9                             1                          3            1
10                            3                          1            1
11                            3                          4            1
12                            3                          3            1
13                            1                          1            1
   push_remember_step1_1 push_score_only_step1_1 push_practice_test_step1_1
1                      3                      NA                          4
2                      4                      NA                         NA
3                      4                      NA                         NA
4                      2                       1                         NA
5                      4                      NA                         NA
6                      4                      NA                         NA
7                      3                      NA                          3
8                      4                      NA                         NA
9                      2                       1                         NA
10                     4                      NA                         NA
11                     2                       1                         NA
12                     2                       1                         NA
13                     4                      NA                         NA
   push_nbme_practice_score_step1_1 push_uw_practice_score_step1_1
1                                65                             NA
2                                NA                             NA
3                                NA                             NA
4                                70                             NA
5                                NA                             NA
6                                NA                             NA
7                                80                             NA
8                                NA                             NA
9                                87                             NA
10                               NA                             NA
11                               83                             NA
12                               30                             NA
13                               NA                             NA
   final_practice_step1_1 final_practice_test_step1_1
1                       1                           6
2                       0                          NA
3                       0                          NA
4                       1                           7
5                       0                          NA
6                       0                          NA
7                       1                           2
8                       1                           7
9                       1                           7
10                      1                           6
11                      1                           5
12                      0                          NA
13                      0                          NA
   final_nbme_practice_score_step1_1 final_uw_practice_score_step1_1
1                                 68                              NA
2                                 NA                              NA
3                                 NA                              NA
4                                 95                              NA
5                                 NA                              NA
6                                 NA                              NA
7                                 97                              NA
8                                 97                              NA
9                                 98                              NA
10                                99                              NA
11                                92                              NA
12                                NA                              NA
13                                NA                              NA
   score_step1_1 retake_step1_1 retake_pass_step1_1 study_amount_step1_1
1              1             NA                  NA                    3
2              1             NA                  NA                    1
3              1             NA                  NA                    1
4              1             NA                  NA                    1
5              1             NA                  NA                    2
6              1             NA                  NA                    2
7              1             NA                  NA                    2
8              1             NA                  NA                    1
9              1             NA                  NA                    1
10             1             NA                  NA                    3
11             1             NA                  NA                    1
12             1             NA                  NA                    1
13             1             NA                  NA                    2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  changes_step1_1
1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Didn't know how to note this above, but I did step 1 anki for the entirety of my last clerkship then spent 2 weeks of dedicated studying 
3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             I would have started reviewing material (i.e. watching B&B, Sketchy pharm) before dedicated started so that I could devote my dedicated time almost exclusively to UWorld questions
6                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           I ended up taking 12 weeks. M1 was terrible for me and I didn't know how to study. So, I would go back and study more for it during M1 or M2 but even 12 weeks was pushing it for me to make up the deficit I was in 
7                                                                                                                                                                                            I wish I would have started the premade anki deck during M1 instead of at the start of M2. I finished about 50% of STEP 1 cards and 75% of STEP 2 cards by the time I took Step 1 and I think it would have been much quicker to a passing score if i had a higher percentage of STEP 1 cards mastered. I did not use UWorld at all because I found that reviewing missed questions didn't help me at all. I never remembered the info or explanations unless I memorized it with anki first. Once I had things memorized, I had no issues applying the knowledge in exam form. The only questions I missed were ones that I had never seen on anki.
8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              I wish it was after pre-clinical year and not after clinical year.
9                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         I wish we had completed step 1 post pre clerkship with dedicated time. 
10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             I would focus on pathophysiology section of uworld
11 I wish I didn't listen to the advice/guidance that my school (HMS) gave me. They really emphasized use of First Aid and at first I followed their guidance (because they shared so little guidance/support overall) even though I have never been a textbook reader, and so I wasted a lot of time studying via methods that were not compatible with my learning style. I also wish I had the opportunity to study with peers or through an HMS class because I also learn much better by talking through concepts with others, but there were no classes/study groups/tutoring or really any support offered by HMS. Given how much we pay for tuition to HMS, I think we should be able to opt-in or sign up for a Step 1 prep course - at a minimum this would provide some structure to an otherwise isolating and irritating experience.
12                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
13                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Spent more time studying during pre-clinical years 
   step_1_first_complete step_2_first_timestamp resources_step2_1___1
1                      2                                            0
2                      2                                            0
3                      2                                            0
4                      2                                            0
5                      2                                            0
6                      2                                            0
7                      2                                            0
8                      2                                            0
9                      2                                            0
10                     2                                            0
11                     2                                            0
12                     2                                            0
13                     2                                            0
   resources_step2_1___2 resources_step2_1___3 resources_step2_1___4
1                      0                     0                     0
2                      0                     0                     0
3                      0                     0                     0
4                      0                     0                     0
5                      0                     0                     0
6                      0                     0                     0
7                      0                     0                     0
8                      0                     0                     0
9                      0                     0                     0
10                     0                     0                     0
11                     0                     0                     0
12                     0                     0                     0
13                     0                     0                     0
   resources_step2_1___5 resources_step2_1___6 resources_step2_1___7
1                      0                     0                     0
2                      0                     0                     0
3                      0                     0                     0
4                      0                     0                     0
5                      0                     0                     0
6                      0                     0                     0
7                      0                     0                     0
8                      0                     0                     0
9                      0                     0                     0
10                     0                     0                     0
11                     0                     0                     0
12                     0                     0                     0
13                     0                     0                     0
   resources_step2_1___8 other_resources_step2_1 other_step2_1
1                      0                                      
2                      0                                      
3                      0                                      
4                      0                                      
5                      0                                      
6                      0                                      
7                      0                                      
8                      0                                      
9                      0                                      
10                     0                                      
11                     0                    <NA>          <NA>
12                     0                    <NA>          <NA>
13                     0                    <NA>          <NA>
   uworld_percent_step2_1 uworld_step2_1 first_aid_step2_1 anki_step2_1
1                      NA             NA                NA           NA
2                      NA             NA                NA           NA
3                      NA             NA                NA           NA
4                      NA             NA                NA           NA
5                      NA             NA                NA           NA
6                      NA             NA                NA           NA
7                      NA             NA                NA           NA
8                      NA             NA                NA           NA
9                      NA             NA                NA           NA
10                     NA             NA                NA           NA
11                     NA             NA                NA           NA
12                     NA             NA                NA           NA
13                     NA             NA                NA           NA
   anki_use_step2_1 anki_details_step2_1___1 anki_details_step2_1___2
1                NA                        0                        0
2                NA                        0                        0
3                NA                        0                        0
4                NA                        0                        0
5                NA                        0                        0
6                NA                        0                        0
7                NA                        0                        0
8                NA                        0                        0
9                NA                        0                        0
10               NA                        0                        0
11               NA                        0                        0
12               NA                        0                        0
13               NA                        0                        0
   anki_details_step2_1___3 anki_details_step2_1___4 anki_details_step2_1___5
1                         0                        0                        0
2                         0                        0                        0
3                         0                        0                        0
4                         0                        0                        0
5                         0                        0                        0
6                         0                        0                        0
7                         0                        0                        0
8                         0                        0                        0
9                         0                        0                        0
10                        0                        0                        0
11                        0                        0                        0
12                        0                        0                        0
13                        0                        0                        0
   anki_details_step2_1___6 anki_details_step2_1___7 sketchy_step2_1
1                         0                        0              NA
2                         0                        0              NA
3                         0                        0              NA
4                         0                        0              NA
5                         0                        0              NA
6                         0                        0              NA
7                         0                        0              NA
8                         0                        0              NA
9                         0                        0              NA
10                        0                        0              NA
11                        0                        0              NA
12                        0                        0              NA
13                        0                        0              NA
   sketchy_details_step2_1___1 sketchy_details_step2_1___2
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           0                           0
13                           0                           0
   sketchy_details_step2_1___3 sketchy_details_step2_1___4
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           0                           0
13                           0                           0
   sketchy_details_step2_1___5 sketchy_details_step2_1___6
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           0                           0
13                           0                           0
   sketchy_details_step2_1___7 amboss_details_step2_1___1
1                            0                          0
2                            0                          0
3                            0                          0
4                            0                          0
5                            0                          0
6                            0                          0
7                            0                          0
8                            0                          0
9                            0                          0
10                           0                          0
11                           0                          0
12                           0                          0
13                           0                          0
   amboss_details_step2_1___2 amboss_details_step2_1___3 amboss_library_step2_1
1                           0                          0                     NA
2                           0                          0                     NA
3                           0                          0                     NA
4                           0                          0                     NA
5                           0                          0                     NA
6                           0                          0                     NA
7                           0                          0                     NA
8                           0                          0                     NA
9                           0                          0                     NA
10                          0                          0                     NA
11                          0                          0                     NA
12                          0                          0                     NA
13                          0                          0                     NA
   amboss_percent_step2_1 amboss_amount_step2_1 pathoma_step2_1 bnb_step2_1
1                      NA                    NA              NA          NA
2                      NA                    NA              NA          NA
3                      NA                    NA              NA          NA
4                      NA                    NA              NA          NA
5                      NA                    NA              NA          NA
6                      NA                    NA              NA          NA
7                      NA                    NA              NA          NA
8                      NA                    NA              NA          NA
9                      NA                    NA              NA          NA
10                     NA                    NA              NA          NA
11                     NA                    NA              NA          NA
12                     NA                    NA              NA          NA
13                     NA                    NA              NA          NA
   bnb_how_step2_1___1 bnb_how_step2_1___2 bnb_how_step2_1___3
1                    0                   0                   0
2                    0                   0                   0
3                    0                   0                   0
4                    0                   0                   0
5                    0                   0                   0
6                    0                   0                   0
7                    0                   0                   0
8                    0                   0                   0
9                    0                   0                   0
10                   0                   0                   0
11                   0                   0                   0
12                   0                   0                   0
13                   0                   0                   0
   bnb_how_step2_1___4 length_step2_1 practicetest_step2_1
1                    0             NA                 <NA>
2                    0             NA                 <NA>
3                    0             NA                 <NA>
4                    0             NA                 <NA>
5                    0             NA                 <NA>
6                    0             NA                 <NA>
7                    0             NA                 <NA>
8                    0             NA                     
9                    0             NA                     
10                   0             NA                     
11                   0             NA                 <NA>
12                   0             NA                 <NA>
13                   0             NA                 <NA>
   practice_test_amount_step2_1 full_test_practice_step2_1
1                            NA                         NA
2                            NA                         NA
3                            NA                         NA
4                            NA                         NA
5                            NA                         NA
6                            NA                         NA
7                            NA                         NA
8                            NA                         NA
9                            NA                         NA
10                           NA                         NA
11                           NA                         NA
12                           NA                         NA
13                           NA                         NA
   final_practice_step2_1 practice_test_step2_1 practice_score_step2_1
1                      NA                    NA                     NA
2                      NA                    NA                     NA
3                      NA                    NA                     NA
4                      NA                    NA                     NA
5                      NA                    NA                     NA
6                      NA                    NA                     NA
7                      NA                    NA                     NA
8                      NA                    NA                     NA
9                      NA                    NA                     NA
10                     NA                    NA                     NA
11                     NA                    NA                     NA
12                     NA                    NA                     NA
13                     NA                    NA                     NA
   score_step2_1 retake_step2_1 retake_pass_step2_1 target_score_step2_1
1                            NA                  NA                   NA
2                            NA                  NA                   NA
3                            NA                  NA                   NA
4                            NA                  NA                   NA
5                            NA                  NA                   NA
6                            NA                  NA                   NA
7                            NA                  NA                   NA
8           <NA>             NA                  NA                   NA
9           <NA>             NA                  NA                   NA
10          <NA>             NA                  NA                   NA
11          <NA>             NA                  NA                   NA
12          <NA>             NA                  NA                   NA
13          <NA>             NA                  NA                   NA
   study_amount_step2_1 changes_step2_1 step_2_first_complete
1                    NA                                     0
2                    NA                                     0
3                    NA                                     0
4                    NA                                     0
5                    NA                                     0
6                    NA                                     0
7                    NA                                     0
8                    NA                                     0
9                    NA                                     0
10                   NA                                     0
11                   NA                                     0
12                   NA                                     0
13                   NA                                     0
   step_1_second_timestamp resources_step1_2___1 resources_step1_2___2
1                                              0                     0
2                                              0                     0
3                                              0                     0
4                                              0                     0
5                                              0                     0
6                                              0                     0
7                                              0                     0
8                                              0                     0
9                                              0                     0
10                                             0                     0
11                                             0                     0
12                                             0                     0
13                                             0                     0
   resources_step1_2___3 resources_step1_2___4 resources_step1_2___5
1                      0                     0                     0
2                      0                     0                     0
3                      0                     0                     0
4                      0                     0                     0
5                      0                     0                     0
6                      0                     0                     0
7                      0                     0                     0
8                      0                     0                     0
9                      0                     0                     0
10                     0                     0                     0
11                     0                     0                     0
12                     0                     0                     0
13                     0                     0                     0
   resources_step1_2___6 resources_step1_2___7 resources_step1_2___8
1                      0                     0                     0
2                      0                     0                     0
3                      0                     0                     0
4                      0                     0                     0
5                      0                     0                     0
6                      0                     0                     0
7                      0                     0                     0
8                      0                     0                     0
9                      0                     0                     0
10                     0                     0                     0
11                     0                     0                     0
12                     0                     0                     0
13                     0                     0                     0
   other_resources_step1_2 other_step1_2 uworld_percent_step1_2
1                     <NA>          <NA>                     NA
2                     <NA>          <NA>                     NA
3                     <NA>          <NA>                     NA
4                     <NA>          <NA>                     NA
5                     <NA>          <NA>                     NA
6                     <NA>          <NA>                     NA
7                     <NA>          <NA>                     NA
8                                                            NA
9                                                            NA
10                                                           NA
11                    <NA>          <NA>                     NA
12                    <NA>          <NA>                     NA
13                    <NA>          <NA>                     NA
   first_aid_step1_2 uworld_step1_2 anki_step1_2 anki_use_step1_2
1                 NA             NA           NA               NA
2                 NA             NA           NA               NA
3                 NA             NA           NA               NA
4                 NA             NA           NA               NA
5                 NA             NA           NA               NA
6                 NA             NA           NA               NA
7                 NA             NA           NA               NA
8                 NA             NA           NA               NA
9                 NA             NA           NA               NA
10                NA             NA           NA               NA
11                NA             NA           NA               NA
12                NA             NA           NA               NA
13                NA             NA           NA               NA
   anki_details_step1_2___1 anki_details_step1_2___2 anki_details_step1_2___3
1                         0                        0                        0
2                         0                        0                        0
3                         0                        0                        0
4                         0                        0                        0
5                         0                        0                        0
6                         0                        0                        0
7                         0                        0                        0
8                         0                        0                        0
9                         0                        0                        0
10                        0                        0                        0
11                        0                        0                        0
12                        0                        0                        0
13                        0                        0                        0
   anki_details_step1_2___4 anki_details_step1_2___5 anki_details_step1_2___6
1                         0                        0                        0
2                         0                        0                        0
3                         0                        0                        0
4                         0                        0                        0
5                         0                        0                        0
6                         0                        0                        0
7                         0                        0                        0
8                         0                        0                        0
9                         0                        0                        0
10                        0                        0                        0
11                        0                        0                        0
12                        0                        0                        0
13                        0                        0                        0
   anki_details_step1_2___7 anki_details_step1_2___8 sketchy_step1_2
1                         0                        0              NA
2                         0                        0              NA
3                         0                        0              NA
4                         0                        0              NA
5                         0                        0              NA
6                         0                        0              NA
7                         0                        0              NA
8                         0                        0              NA
9                         0                        0              NA
10                        0                        0              NA
11                        0                        0              NA
12                        0                        0              NA
13                        0                        0              NA
   sketchy_details_step1_2___1 sketchy_details_step1_2___2
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           0                           0
13                           0                           0
   sketchy_details_step1_2___3 sketchy_details_step1_2___4
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           0                           0
13                           0                           0
   sketchy_details_step1_2___5 sketchy_details_step1_2___6
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           0                           0
13                           0                           0
   sketchy_details_step1_2___7 sketchy_details_step1_2___8
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           0                           0
13                           0                           0
   amboss_details_step1_2___1 amboss_details_step1_2___2
1                           0                          0
2                           0                          0
3                           0                          0
4                           0                          0
5                           0                          0
6                           0                          0
7                           0                          0
8                           0                          0
9                           0                          0
10                          0                          0
11                          0                          0
12                          0                          0
13                          0                          0
   amboss_details_step1_2___3 amboss_library_step1_2 amboss_percent_step1_2
1                           0                     NA                     NA
2                           0                     NA                     NA
3                           0                     NA                     NA
4                           0                     NA                     NA
5                           0                     NA                     NA
6                           0                     NA                     NA
7                           0                     NA                     NA
8                           0                     NA                     NA
9                           0                     NA                     NA
10                          0                     NA                     NA
11                          0                     NA                     NA
12                          0                     NA                     NA
13                          0                     NA                     NA
   amboss_amount_step1_2 pathoma_step1_2 bnb_step1_2 bnb_how_step1_2___1
1                     NA              NA          NA                   0
2                     NA              NA          NA                   0
3                     NA              NA          NA                   0
4                     NA              NA          NA                   0
5                     NA              NA          NA                   0
6                     NA              NA          NA                   0
7                     NA              NA          NA                   0
8                     NA              NA          NA                   0
9                     NA              NA          NA                   0
10                    NA              NA          NA                   0
11                    NA              NA          NA                   0
12                    NA              NA          NA                   0
13                    NA              NA          NA                   0
   bnb_how_step1_2___2 bnb_how_step1_2___3 bnb_how_step1_2___4 length_step1_2
1                    0                   0                   0             NA
2                    0                   0                   0             NA
3                    0                   0                   0             NA
4                    0                   0                   0             NA
5                    0                   0                   0             NA
6                    0                   0                   0             NA
7                    0                   0                   0             NA
8                    0                   0                   0             NA
9                    0                   0                   0             NA
10                   0                   0                   0             NA
11                   0                   0                   0             NA
12                   0                   0                   0             NA
13                   0                   0                   0             NA
   practicetest_step1_2 practice_test_amount_step1_2 full_test_practice_step1_2
1                  <NA>                           NA                         NA
2                  <NA>                           NA                         NA
3                  <NA>                           NA                         NA
4                  <NA>                           NA                         NA
5                  <NA>                           NA                         NA
6                  <NA>                           NA                         NA
7                  <NA>                           NA                         NA
8                                                 NA                         NA
9                                                 NA                         NA
10                                                NA                         NA
11                 <NA>                           NA                         NA
12                 <NA>                           NA                         NA
13                 <NA>                           NA                         NA
   push_step1_2 push_remember_step1_2 push_score_only_step1_2
1            NA                    NA                      NA
2            NA                    NA                      NA
3            NA                    NA                      NA
4            NA                    NA                      NA
5            NA                    NA                      NA
6            NA                    NA                      NA
7            NA                    NA                      NA
8            NA                    NA                      NA
9            NA                    NA                      NA
10           NA                    NA                      NA
11           NA                    NA                      NA
12           NA                    NA                      NA
13           NA                    NA                      NA
   push_practice_test_step1_2 push_nbme_practice_score_step1_2
1                          NA                               NA
2                          NA                               NA
3                          NA                               NA
4                          NA                               NA
5                          NA                               NA
6                          NA                               NA
7                          NA                               NA
8                          NA                               NA
9                          NA                               NA
10                         NA                               NA
11                         NA                               NA
12                         NA                               NA
13                         NA                               NA
   push_uw_practice_score_step1_2 final_practice_step1_2
1                              NA                     NA
2                              NA                     NA
3                              NA                     NA
4                              NA                     NA
5                              NA                     NA
6                              NA                     NA
7                              NA                     NA
8                              NA                     NA
9                              NA                     NA
10                             NA                     NA
11                             NA                     NA
12                             NA                     NA
13                             NA                     NA
   final_practice_test_step1_2 final_nbme_practice_score_step1_2
1                           NA                                NA
2                           NA                                NA
3                           NA                                NA
4                           NA                                NA
5                           NA                                NA
6                           NA                                NA
7                           NA                                NA
8                           NA                                NA
9                           NA                                NA
10                          NA                                NA
11                          NA                                NA
12                          NA                                NA
13                          NA                                NA
   final_uw_practice_score_step1_2 score_step1_2 retake_step1_2
1                               NA            NA             NA
2                               NA            NA             NA
3                               NA            NA             NA
4                               NA            NA             NA
5                               NA            NA             NA
6                               NA            NA             NA
7                               NA            NA             NA
8                               NA            NA             NA
9                               NA            NA             NA
10                              NA            NA             NA
11                              NA            NA             NA
12                              NA            NA             NA
13                              NA            NA             NA
   retake_pass_step1_2 study_amount_step1_2 changes_step1_2
1                   NA                   NA                
2                   NA                   NA                
3                   NA                   NA                
4                   NA                   NA                
5                   NA                   NA                
6                   NA                   NA                
7                   NA                   NA                
8                   NA                   NA                
9                   NA                   NA                
10                  NA                   NA                
11                  NA                   NA            <NA>
12                  NA                   NA            <NA>
13                  NA                   NA            <NA>
   step_1_second_complete step_2_second_timestamp resources_step2_2___1
1                       0             2/8/23 9:35                     1
2                       0            2/8/23 10:12                     1
3                       0           2/16/23 20:15                     1
4                       0           2/20/23 13:01                     1
5                       0                                             0
6                       0                                             0
7                       0                                             0
8                       0                                             0
9                       0     2023-09-07 09:50:43                     1
10                      0     2023-09-07 16:06:06                     1
11                      0                                             0
12                      0     2023-10-04 08:42:48                     1
13                      0     2023-10-04 15:31:29                     1
   resources_step2_2___2 resources_step2_2___3 resources_step2_2___4
1                      1                     0                     0
2                      1                     0                     1
3                      0                     1                     0
4                      0                     1                     0
5                      0                     0                     0
6                      0                     0                     0
7                      0                     0                     0
8                      0                     0                     0
9                      0                     0                     0
10                     0                     0                     0
11                     0                     0                     0
12                     0                     1                     1
13                     0                     0                     0
   resources_step2_2___5 resources_step2_2___6 resources_step2_2___7
1                      0                     0                     0
2                      0                     0                     0
3                      0                     0                     0
4                      0                     0                     0
5                      0                     0                     0
6                      0                     0                     0
7                      0                     0                     0
8                      0                     0                     0
9                      0                     0                     0
10                     0                     0                     0
11                     0                     0                     0
12                     1                     1                     1
13                     0                     0                     0
   resources_step2_2___8
1                      0
2                      0
3                      0
4                      1
5                      0
6                      0
7                      0
8                      0
9                      0
10                     0
11                     0
12                     0
13                     1
                                      other_resources_step2_2 other_step2_2
1                                                                          
2                                                                          
3                                                                          
4                                Divine Intervention Podcasts           Yes
5                                                                          
6                                                                          
7                                                                          
8                                                                          
9                                                                          
10                                                                         
11                                                                         
12                                                                         
13 Summary PDFs/content review I found online, youtube videos           Yes
   uworld_percent_step2_2 uworld_step2_2 first_aid_step2_2 anki_step2_2
1                      70              1                 2           NA
2                      66              3                 1           NA
3                      65              1                NA            1
4                      80              1                NA            1
5                      NA             NA                NA           NA
6                      NA             NA                NA           NA
7                      NA             NA                NA           NA
8                      NA             NA                NA           NA
9                      50              1                NA           NA
10                     61              1                NA           NA
11                     NA             NA                NA           NA
12                     94              3                NA            1
13                     71              1                NA           NA
   anki_use_step2_2 anki_details_step2_2___1 anki_details_step2_2___2
1                NA                        0                        0
2                NA                        0                        0
3                 3                        0                        0
4                 3                        1                        0
5                NA                        0                        0
6                NA                        0                        0
7                NA                        0                        0
8                NA                        0                        0
9                NA                        0                        0
10               NA                        0                        0
11               NA                        0                        0
12                3                        0                        0
13               NA                        0                        0
   anki_details_step2_2___3 anki_details_step2_2___4 anki_details_step2_2___5
1                         0                        0                        0
2                         0                        0                        0
3                         1                        0                        0
4                         0                        0                        0
5                         0                        0                        0
6                         0                        0                        0
7                         0                        0                        0
8                         0                        0                        0
9                         0                        0                        0
10                        0                        0                        0
11                        0                        0                        0
12                        1                        0                        0
13                        0                        0                        0
   anki_details_step2_2___6 anki_details_step2_2___7 anki_details_step2_2___8
1                         0                        0                        0
2                         0                        0                        0
3                         0                        1                        0
4                         0                        0                        0
5                         0                        0                        0
6                         0                        0                        0
7                         0                        0                        0
8                         0                        0                        0
9                         0                        0                        0
10                        0                        0                        0
11                        0                        0                        0
12                        0                        1                        0
13                        0                        0                        0
   sketchy_step2_2 sketchy_details_step2_2___1 sketchy_details_step2_2___2
1               NA                           0                           0
2                1                           1                           0
3               NA                           0                           0
4               NA                           0                           0
5               NA                           0                           0
6               NA                           0                           0
7               NA                           0                           0
8               NA                           0                           0
9               NA                           0                           0
10              NA                           0                           0
11              NA                           0                           0
12               1                           0                           1
13              NA                           0                           0
   sketchy_details_step2_2___3 sketchy_details_step2_2___4
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           1                           0
13                           0                           0
   sketchy_details_step2_2___5 sketchy_details_step2_2___6
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           0                           0
13                           0                           0
   sketchy_details_step2_2___7 sketchy_details_step2_2___8
1                            0                           0
2                            0                           0
3                            0                           0
4                            0                           0
5                            0                           0
6                            0                           0
7                            0                           0
8                            0                           0
9                            0                           0
10                           0                           0
11                           0                           0
12                           1                           0
13                           0                           0
   amboss_details_step2_2___1 amboss_details_step2_2___2
1                           0                          0
2                           0                          0
3                           0                          0
4                           0                          0
5                           0                          0
6                           0                          0
7                           0                          0
8                           0                          0
9                           0                          0
10                          0                          0
11                          0                          0
12                          1                          1
13                          0                          0
   amboss_details_step2_2___3 amboss_library_step2_2 amboss_percent_step2_2
1                           0                     NA                     NA
2                           0                     NA                     NA
3                           0                     NA                     NA
4                           0                     NA                     NA
5                           0                     NA                     NA
6                           0                     NA                     NA
7                           0                     NA                     NA
8                           0                     NA                     NA
9                           0                     NA                     NA
10                          0                     NA                     NA
11                          0                     NA                     NA
12                          1                      1                     41
13                          0                     NA                     NA
   amboss_amount_step2_2 pathoma_step2_2 bnb_step2_2 bnb_how_step2_2___1
1                     NA              NA          NA                   0
2                     NA              NA          NA                   0
3                     NA              NA          NA                   0
4                     NA              NA          NA                   0
5                     NA              NA          NA                   0
6                     NA              NA          NA                   0
7                     NA              NA          NA                   0
8                     NA              NA          NA                   0
9                     NA              NA          NA                   0
10                    NA              NA          NA                   0
11                    NA              NA          NA                   0
12                     3               1           1                   1
13                    NA              NA          NA                   0
   bnb_how_step2_2___2 bnb_how_step2_2___3 bnb_how_step2_2___4 length_step2_2
1                    0                   0                   0              4
2                    0                   0                   0              3
3                    0                   0                   0              5
4                    0                   0                   0              5
5                    0                   0                   0             NA
6                    0                   0                   0             NA
7                    0                   0                   0             NA
8                    0                   0                   0             NA
9                    0                   0                   0              4
10                   0                   0                   0              4
11                   0                   0                   0             NA
12                   0                   0                   0              4
13                   0                   0                   0              4
   practicetest_step2_2 practice_test_amount_step2_2 full_test_practice_step2_2
1                     4                            1                          3
2                     3                            3                          4
3                     5                            2                          4
4                     4                            1                          3
5                                                 NA                         NA
6                                                 NA                         NA
7                                                 NA                         NA
8                  <NA>                           NA                         NA
9                     3                            1                          3
10                    3                            1                          1
11                 <NA>                           NA                         NA
12                    3                            3                          3
13                    5                            1                          1
   final_practice_step2_2 practice_test_step2_2 practice_score_step2_2
1                       0                    NA                       
2                       1                     7                    251
3                       1                     3                    243
4                       1                     7                    242
5                      NA                    NA                       
6                      NA                    NA                       
7                      NA                    NA                       
8                      NA                    NA                   <NA>
9                       0                    NA                   <NA>
10                      0                    NA                   <NA>
11                     NA                    NA                   <NA>
12                      0                    NA                   <NA>
13                      1                     5                    235
   score_step2_2 retake_step2_2 retake_pass_step2_2 target_score_step2_2
1            239             NA                  NA                    3
2            250             NA                  NA                    1
3   no score yet             NA                  NA                    1
4            244             NA                  NA                    1
5                            NA                  NA                   NA
6                            NA                  NA                   NA
7                            NA                  NA                   NA
8                            NA                  NA                   NA
9            n/a             NA                  NA                    1
10           253             NA                  NA                    1
11          <NA>             NA                  NA                   NA
12           266             NA                  NA                    2
13           230             NA                  NA                    3
   study_amount_step2_2
1                     2
2                     1
3                     2
4                     1
5                    NA
6                    NA
7                    NA
8                    NA
9                     1
10                    2
11                   NA
12                    1
13                    2
                                                                                                                                                                      changes_step2_2
1                                                                                                                                                                                    
2                                                                                                                                                                                    
3                                                                                                                                                                                    
4                                                                                                                                                                                    
5                                                                                                                                                                                    
6                                                                                                                                                                                    
7                                                                                                                                                                                    
8                                                                                                                                                                                    
9                                                                                             Dedicated time exclusive to step 2 post clerkship with step 1 completed pre-clerkship. 
10                                                                                                                                                                                   
11                                                                                                                                                                                   
12 Simulate a full day exam before taking the test. I had done half length practice tests leading up to it but found that I got fatigued on the test day for the last three sections.
13                                                                                               Studied more for Step 1. Would have done Anki in the months leading up to the exam. 
   step_2_second_complete  uniqueID
1                       2    VUSM 7
2                       2   VUSM 12
3                       2   VUSM 39
4                       2   VUSM 51
5                       0    VUSM 9
6                       0   VUSM 20
7                       0   VUSM 57
8                       0 UVASOM 12
9                       2 UVASOM 67
10                      2 UVASOM 79
11                      0    HMS 30
12                      2    HMS 55
13                      2    HMS 58
Code
step1_complete$push_practice_test_step1 <- factor(step1_complete$push_practice_test_step1, levels = c(1:8), labels = c("NBME 25", "NBME 26", "NBME 27", "NBME 28", "NBME 29", "NBME 30", "UWorld 1", "UWorld 2"))

units(step1_complete$push_uw_practice_score_step1) <- "score units"
units(step1_complete$push_nbme_practice_score_step1) <- "percent"
label(step1_complete$push_practice_test_step1) <- "exam that triggered pushing back"
label(step1_complete$push_nbme_practice_score_step1) <- "NBME P(passing) that triggered pushing back"
label(step1_complete$push_uw_practice_score_step1) <- "3 digit UWorld score that triggered pushing back"
caption <- "Description of indiviuals that pushed back Step 1"
table1(~ push_practice_test_step1 + push_uw_practice_score_step1 + push_nbme_practice_score_step1 |push_step1_label, data=step1_complete, topclass="Rtable1-zebra")
Yes
(N=20)
No
(N=162)
Overall
(N=182)
exam that triggered pushing back
NBME 25 0 (0%) 0 (0%) 0 (0%)
NBME 26 0 (0%) 0 (0%) 0 (0%)
NBME 27 1 (5.0%) 0 (0%) 1 (0.5%)
NBME 28 1 (5.0%) 0 (0%) 1 (0.5%)
NBME 29 0 (0%) 0 (0%) 0 (0%)
NBME 30 0 (0%) 0 (0%) 0 (0%)
UWorld 1 0 (0%) 0 (0%) 0 (0%)
UWorld 2 1 (5.0%) 0 (0%) 1 (0.5%)
Missing 17 (85.0%) 162 (100%) 179 (98.4%)
3 digit UWorld score that triggered pushing back (score units)
Mean (SD) 180 (NA) NA (NA) 180 (NA)
Median [Min, Max] 180 [180, 180] NA [NA, NA] 180 [180, 180]
Missing 19 (95.0%) 162 (100%) 181 (99.5%)
NBME P(passing) that triggered pushing back (percent)
Mean (SD) 65.6 (18.3) NA (NA) 65.6 (18.3)
Median [Min, Max] 67.5 [30.0, 87.0] NA [NA, NA] 67.5 [30.0, 87.0]
Missing 12 (60.0%) 162 (100%) 174 (95.6%)

Descriptive statistics will be reported in total and not by school (as requested by the collaborators).

  • Question banks

    • % UWorld for step 1 and 2
    • % Amboss for step 1 and 2
  • length of study for step 1 and step 2 (barplot with frequency table)

  • 3 of practice tests (recoded from a text answer from “How many total practice tests did you take before Step 2?”)

  • full test day as factor from “Did you simulate a full Step 2 test day experience, e.g. 8 blocks of 40 UWorld questions or 2 of the 4-section practice tests?” “full_practice_test”

  • histogram of Step 2 scores

  • what resources are most widely used barplot

  • number of practice tests histogram (among the people who answered the question)

  • summarize comments for other_resources, other_step, changes_step

Practice Scores for Step 1 and Step 2 - probability of passing for step 1 - final_nbme_practice_score_step1 is a percent from 0 to 100 - final_uw_practice_score_step1 is a 3 digit UWorld score for step 1 - final practice score for step 2 (3 digit score)

looking at the data dictionary, we are given final_nbme_practice _score_step1 and final_uw_practice_s core_step1 which are two different covariates which are ONLY in Step 1.

Since everyone passed step 1, I did not run a regression model that included these covariates. Instead, I will make a plot to show this in descriptive data.

These specific questions were not included for step 2, instead there is a question for practice_score_step2, which I do include in the model for step 2 score predictors above.

Code
## do a plot for all schools (in total) as well as Vanderbilt in particular
## use a unified color scheme

ggplot(aes(x = score_step2), data= step2_complete) + geom_histogram() + theme_minimal() + xlab("Self Reported Step 2 Score") + ylab("Frequency") + labs(title = "Frequency of reported Step 2 Scores")
`stat_bin()` using `bins = 30`. Pick better value with `binwidth`.

Code
#more data cleaning first first step 2 for the resouces they selected that they used
resources_step2 <- colSums(took_step2general[20:35])
uworld <- resources_step2[1] + resources_step2[9]
first_aid <- resources_step2[2] + resources_step2[10]
anki <- resources_step2[3] + resources_step2[11]
sketchy <- resources_step2[4] +resources_step2[12]
amboss <- resources_step2[5] + resources_step2[13]
pathoma <- resources_step2[6] + resources_step2[14]
boards_and_beyond <- resources_step2[7] + resources_step2[15]
other <- resources_step2[8] + resources_step2[16]
totals <- c(uworld, first_aid, anki, sketchy, amboss, pathoma, boards_and_beyond, other)

#same idea for step 1
resources_step1 <- colSums(took_step1general[26:41])
uworld1 <- resources_step1[1] + resources_step1[9]
first_aid1 <- resources_step1[2] + resources_step1[10]
anki1 <- resources_step1[3] + resources_step1[11]
sketchy1 <- resources_step1[4] +resources_step1[12]
amboss1 <- resources_step1[5] + resources_step1[13]
pathoma1 <- resources_step1[6] + resources_step1[14]
boards_and_beyond1 <- resources_step1[7] + resources_step1[15]
other1 <- resources_step1[8] + resources_step1[16]
totals1 <- c(uworld1, first_aid1, anki1, sketchy1, amboss1, pathoma1, boards_and_beyond1, other1)

rdf <- data.frame(amount = c(totals, totals1), name = rep(names(totals), 2), step_exam = c(rep("Step 2", 8), rep("Step 1", 8) ))

# http://www.sthda.com/english/wiki/ggplot2-barplots-quick-start-guide-r-software-and-data-visualization used this as a guide

#what resources are most widely used? I want to sort this barplot in order of frequency but for some reason this wasn't working for me with reorder()
ggplot(data=rdf, aes(x=name, y=amount, fill = step_exam)) +
  geom_bar(stat="identity", position=position_dodge())+
  theme_minimal() + coord_flip() + scale_fill_brewer(palette="Blues")

Code
## how long did the students study barplot
       # for step 1
step1_complete$length_step1 <- factor(step1_complete$length_step1 , levels = c(1:6), labels = c("less than 1 week", "1-2 weeks", "3-4 weeks", "5-6 weeks", "7-8 weeks", "more than 8 weeks"))

ggplot(data.frame(step1_complete), aes(x=length_step1)) + geom_bar() + theme_minimal() + xlab("Time") + ylab("Frequency") + labs(title = "How long did you study for Step 1 during a protected study period?")

Code
       # for step 2
ggplot(data.frame(step2_complete), aes(x=length_step2)) + geom_bar() + theme_minimal() + xlab("Time") + ylab("Frequency") + labs(title = "How long did you study for Step 2 during a protected study period?")

Code
## number of practice tests histogram (among the people who answered the question)
ggplot(aes(x = number_of_practice_tests), data= step2_complete) + geom_histogram() + theme_minimal() + xlab("Number of tests") + ylab("Frequency") + labs(title = "How many total practice tests did you take before Step 2?")
`stat_bin()` using `bins = 30`. Pick better value with `binwidth`.
Warning: Removed 7 rows containing non-finite values (`stat_bin()`).

Code
ggplot(aes(x = practicetest_step1), data= step1_complete) + geom_histogram() + theme_minimal() + xlab("Number of tests") + ylab("Frequency") + labs(title = "How many total practice tests did you take before Step 1?")
`stat_bin()` using `bins = 30`. Pick better value with `binwidth`.
Warning: Removed 29 rows containing non-finite values (`stat_bin()`).

Code
## summarize comments (other_resources, other_step, changes_step)
#"other_resources_step1"           "other_step1"                     "changes_step1"   
kable(table(step1_complete$other_resources_step1), caption = "Other listed resources for Step 1")
Other listed resources for Step 1
Var1 Freq
121
Dirty Medicine 1
Dirty Medicine YouTube videos 1
NBME and Dr. Legallo's videos and notes from preclinical 1
nbme practice exams 1
NBME practice tests 1
Online MedEd 1
Pixorize 1
Youtube 1
Code
#If you used other resources not listed above, would you use them again?
step1_complete$other_hascontents <- as.integer(nchar(step1_complete$other_resources_step1) > 0) #flagging the rows that have contents https://stackoverflow.com/questions/64744988/testing-to-see-if-characters-are-present-in-a-cell-in-r
as_tibble(step1_complete[which(step1_complete$other_hascontents == 1), c("other_resources_step1", "other_step1") ])
# A tibble: 8 × 2
  other_resources_step1                                    other_step1          
  <chr>                                                    <chr>                
1 Pixorize                                                 Yes, helped immensel…
2 Dirty Medicine YouTube videos                            yes                  
3 Dirty Medicine                                           Yes                  
4 nbme practice exams                                      yes                  
5 NBME practice tests                                      Yes                  
6 Youtube                                                  Yes                  
7 Online MedEd                                             Maybe                
8 NBME and Dr. Legallo's videos and notes from preclinical yes, NBME and Dr. Le…
Code
# what would you change?
step1_complete$change_hascontents <- as.integer(nchar(step1_complete$changes_step1) > 0) 
as_tibble(step1_complete[which(step1_complete$change_hascontents == 1), "changes_step1" ])
# A tibble: 39 × 1
   value                                                                        
   <chr>                                                                        
 1 "I would ditch pathoma and just do Anki, UWorld, sketchy and pixorize just f…
 2 "I did it in 3 weeks and it was VERY stressful. However, this ended up being…
 3 "Would have started earlier in preclinical - would have ignored my preclinic…
 4 "I would have studied for 4 weeks instead of 6 weeks. However, I took my tes…
 5 "More SketchyMicro. Start using outside resources during 1st year. More UWor…
 6 "I could have studied less (like 3-4 weeks) because I was consistently scori…
 7 "I would make all of my study time part time (like I did when at home for th…
 8 "I took about 3 weeks to review Sketchy Micro/Pharm and Pathoma as well as d…
 9 "Focus more on the things that overlap with step 2"                          
10 "I just used sketchy/anki for micro, and that was great. I don't love it for…
# ℹ 29 more rows
Code
#dat$study_amount_step1_1

4 Appendix/notes

All the analyses are performed using the following:

  • R version 4.2.2 (2022-06-24); R Core Team (2022). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.

  • Harrell Jr FE (2022). rms: Regression Modeling Strategies. R package version 6.3-0, https://CRAN.R-project.org/package=rms.

The table below lists packages used in this document.

Code
subset(data.frame(sessioninfo::package_info()), attached==TRUE, c(package, loadedversion))
                  package loadedversion
cowplot           cowplot         1.1.1
dplyr               dplyr         1.1.3
forcats           forcats         1.0.0
GGally             GGally         2.1.2
ggplot2           ggplot2         3.4.4
gridExtra       gridExtra           2.3
gtsummary       gtsummary         1.7.2
Hmisc               Hmisc         5.1-1
knitr               knitr          1.44
lubridate       lubridate         1.9.3
modelsummary modelsummary         1.4.3
plotly             plotly        4.10.2
purrr               purrr         1.0.2
readr               readr         2.1.4
rms                   rms         6.7-1
sandwich         sandwich         3.0-2
scales             scales         1.2.1
stringr           stringr         1.5.0
table1             table1         1.4.3
tibble             tibble         3.2.1
tidyr               tidyr         1.3.0
tidyverse       tidyverse         2.0.0
viridis           viridis         0.6.4
viridisLite   viridisLite         0.4.2
visdat             visdat         0.6.0